Netzafon: Netzer fun in the North 5777 2016/17

Application Form (one form per participant)

Netzafon is a new exciting programme set up for all of the northern communities. It is a chance to get together and enjoy the RSY- Netzer environment and have lots of kef (fun) all year round! Each of the 5 Netzafon weekends will be bursting with exciting peulot (activities), sports, creative Jewish education and on some of the weekends you will have the chance to enjoy site activities and team building tasks on an outdoor site. Over the course of the year you will make new friends, and see them throughout the year and either continue on your RSY-Netzer Journey, or get the perfect introduction to RSY-Netzer so your journey can begin.

Parent/Guardian Contact Details

Second Parent/Guardian Details (not required)

Name

First Name Last Name

Home Phone

Mobile Phone

Work Phone

Email

Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Emergency Contact

Please give contact details of someone other than the parent/guardian that we can contact if we were unable to reach the parent/guardian. It is important that you notify this person that they are an emergency contact and that they need to be in the UK, and contactable during the entire event period.

Name
*

First Name Last Name

Relationship to participant
*

Home Phone

Mobile Phone
*

E-mail

MEDICAL AND WELFARE FORM

The information you provide us with will be kept in the strictest of confidence. For your benefit, it is essential that even sensitive information is written. Please include all details that will allow us to support your child during this event. We are able to accommodate many special needs but withholding medical and/or welfare information could lead to you being withdrawn from the event.

Please give details of any dietary requirements. (We are a vegetarian movement)

Please give details of any other medical and/or welfare conditions the participant may have suffered, presently or in the past (e.g. eating disorders, compulsive behaviour) – please be honest so that we can give appropriate support.

Payment:

Your payment can be made online on paypal, or by cheque, bank transfer or cash.

You can choose to sign up to all 5 events or per weekend.

Cost:

All 5 events - £159

Single weekends (priced individually)

Payment Options

Paypal Over the phone (call 020 8349 5683)

Payment by Paypal

All 5 Events
£
159.00
GBP

October 7th-9th 2016
£
59.00
GBP

November 25th-27th 2016
£
24.00
GBP

January 27th-29th 2017
£
24.00
GBP

March 24th-26th 2017
£
24.00
GBP

May 5th-7th 2017
£
59.00
GBP

RSY-Netzer Bursary Donation
£
1.00
GBP

Quantity

Total:
£
0.00
GBP

Payments by cheque/cash

(Cheques should be made payable to: The Movement for Reform Judaism)Cash or Cheques should be sent to

Address: The Sternberg Centre, 80 East End Road, Finchley, N3 2SY

You can also opt to help raise substatial funds to help provide a strong Financial Assistance Fund. If you would like to make a small donation, you will help another young person to experience this event.

RSY-Netzer strongly believes that our young people should have the opportunity to take part in our events and we strive to support this in every way we can. If you require financial assistance, please find the form on our website www.rsy-netzer.org.uk/netzafon or contact Alyson Joseph on 02083495666 or aly.joseph@rsy-netzer.org.uk.